DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

PATIALA.

                                      Consumer Complaint No. 152 of 12.4.2016

                                      Decided on: 22.12.2020

1. Ranjita Chawla Wd/o Sh.Ashok Kumar R/o H.No.7752/5, Upkar Nagar, Factory Area, Patiala-147001,District Patiala.
2. Hitesh Chawla s/o Late Sh.Ashok Kumar R/o H.No.7752/5, Upkaar Nagar, Factory Area, Patiala-147001 District Patiala.

                                                                   …………...Complainants

                                      Versus

1. SBI Life Insurance Company Ltd., Regd. office”Natraj”, M.V.Road & Western Express Highway Junction, Andheri(East),Mumbai-400069 through its Director/Authorized Signatory.
2. SBI Life Insurance Company Ltd.,having Branch office at State Bank of Patiala, Arya Samaj, Patiala through its Branch Manager.
3. State Bank of Patiala( Now State Bank of India) Branch Arya Samaj, Patiala through its Branch Manager.

                                                                   …………Opposite Parties

                                      Complaint under Section 12 of the

                                      Consumer Protection Act, 1986.

QUORUM

                                      Sh. Jasjit Singh Bhinder, President

                                      Sh.Y.S.Matta, Member 

ARGUED BY              

                                       Sh.Vinay Sood, counsel for the complainant.

                                      Sh.Puneet Gupta, counsel for OPs No.1&2.                 

                                      Opposite party No.3 ex-parte.                                               

 ORDER

                                      JASJIT SINGH BHINDER,PRESIDENT

1. This is the complaint filed by Ranjita Chawla and another (hereinafter referred to as the complainant) against SBI Life Insurance Company Ltd. & Others(hereinafter referred to as the OP/s) under the Consumer Protection Act,1986(hereinafter referred to as the Act).
2. Briefly the case of the complainant is that deceased Ashok Kumar,   husband of complainant No.1 and father of complainant No.2 , purchased a car by obtaining car/vehicle loan from State Bank of Patiala i.e. OP No.3 and the said loan was insured with OPs vide policy No.70000004006, issued under RINN RAKSHA POLICY and was commenced on 29.1.2014 for the period of one year.
3. It is averred that Ashok Kumar died on 10.10.2014.The complainants lodged the insurance claim with the OPs, which was repudiated by them on 13.12.2014, on the ground that insured was suffering from Chronic Kidney Disease, diabetes Mellitus, Hypertension and had underwent Renal Transplant, prior to the commencement of risk.
4. It is averred that during communication with the loanee bank i.e. SBOP, the bank officials handed over the copy of blank proposal form signed by deceased/insured Ashok Kumar to complainant No.2, which was handed over to OP No.2 while purchasing the policy in the premises of OP No.2.
5. It is further averred that after repudiation of the claim, the complainants approached to the Insurance Ombudsman, where the OPs were directed to refund the insurance premium paid by deceased Ashok Kumar for which the complainants were not satisfied.
6. It is averred that in the proceedings before Insurance Ombudsman, the OPs produced false and forged proposal form by forging the signatures of Ashok Kumar as blank proposal form was signed by the deceased
   Ashok Kumar, which was lateron filled by the officials of OPs.  
7. It is further averred that the OPs in collusion with each other have forged the signatures of Ashok Kumar on the proposal form, just to grab the insurance claim of complainants. The non giving of insurance claim to the complainants and making false excuses by the OPs is deficiency in service and unfair trade practice on the part of OPs.
8. It is further averred that legal notice was also got served upon the OPs with the request to make the insurance claim but they refused to release the insurance claim, which caused lot of mental agony and harassment to the complainant.
9. On this background  of the facts, the complainants have filed this complaint with the prayer to accept the same by giving directions to the OPs to pay the insurance claim alongwith interest @18% per annum and also to pay Rs.2,00,000/- as compensation for causing mental agony and harassment to the complainant and Rs.25000/- as litigation expenses.
10. Upon notice OPs No.1&2 appeared through counsel and contested the complaint by filing written reply where as OP No.3 did not appear inspite of service of notice and was accordingly proceeded against ex-parte vide order dated 8.6.2018.
11. In the written reply filed by OPs No.1&2, at the outset it  is submitted that the OPs have such a scheme of group insurance called “RINN Raksha” for the borrowers of various categories of loan of State Bank of Patiala, where under the borrower member is offered insurance subject to the terms and conditions incorporated in the Master Policy and the privity of contract is between the master policy holder( In the instant case State Bank of Patiala and the Insurer (SBI Life).
12. The OPs have also raised preliminary objections to the effect that the present complaint is not maintainable for want of territorial jurisdiction; that complaint involves complicated questions of law and facts for which only civil court is competent to handle such cases and that there is no unfair trade practice, forgery of signature or deficiency in service on the part of the OPs.
13. On merits, it is admitted that deceased life assured late Ashok Kumar took car loan from SBOP and applied for insurance cover through membership form No.7004175592 dated 28.1.2014 and the risk was commenced on 29.1.2014 for basic sum assured of Rs.2,76,000/-. It is submitted that certificate of insurance was also issued to the DLA.
14. It is further submitted that the risk cover under the said group insurance scheme is of diminishing nature and the sum assured tapers down as the EMIs are paid off. It  is further submitted that as per point No.20, sub clause I, Death benefits of the COI, the outstanding loan amount as on the date of death was Rs.2,61,455/-.
15. It is further averred that for getting the insurance cover, the life assured should submit a declaration of good health alongwith other details in the membership form, confirming that he/she is in sound health and does not suffer from any illness or critical illness and any suppression of material fact in the DGH is constituted a breach of Doctrine of utmost good faith.
16. It is further submitted that in the membership form for Rinn Raksha Group Insurance Plan, the DLA signed the declaration of good health having  suppressed material information that he was suffering from Chronic Kidney Disease, Diabetes Mellitus, Hypertension and had undergone Renal Transplant prior to the date of commencement  of the cover. The policy being resulted in an early claim i.e. just in 8 months 11 days, the OPs enquired into the matter. As per the Discharge summary issued by Surya Kidney Care, Mohali, the DLA was admitted on 15.6.2011 and was discharged on 18.6.2011 and in the diagnosis it is noted that the DLA was diagnosed with Diabetic Nephropathy, Neuropathy/DMII/HTN/CKD/UTI. Further he was admitted for the same problem on 2.7.2011 and was discharged on 5.7.2011.He was again admitted on 14.11.2011 and was discharged on 22.11.2011. The deceased was again admitted on 2.1.2012 and was discharged on 4.1.2012, again admitted on 17.1.2012 and was discharged on 18.1.2012, again admitted on 27.5.2015 and was discharged on 29.5.2014.
17. It  is further submitted that as per the certificate dated 27.1.2012, issued by Dr.B.S.Satya Sree of Surya Kidney Care, the DLA underwent Renal Transplant on 16.11.2011 and was discharged on 22.11.2011. It is further submitted that as per the employer’s certificate,  issued in the name of DLA, the deceased underwent Renal Transplant and was remained on leave for the duration of 14.11.2011 to 14.1.2012. It is further submitted that all the documents show that the DLA has suppressed his past medical history of Chronic Kidney Disease, Diabetes Mellitus, Hyper tension and had undergone Renal Transplant and had given false declaration at the time of applying for insurance cover. Hence the claim was repudiated on legal and valid grounds by the OPs. There is no deficiency in service and unfair trade practice on the part of the  OPs.

After denying all other averments made in the complaint, the OPs prayed for the dismissal of the complaint.

18. In evidence, the ld. counsel for the complainant has tendered Ex.CA affidavit of the complainant alongwith documents Exs.C1 to C9 and closed the evidence.
19. The ld. counsel for OPs No.1&2 tendered Ex.OPA affidavit of Ms Neelam Singh, Sr.Legal Manager of OPs alongwith documents Exs.OP1 to OP17 and closed the evidence.
20. The OPs have filed the written arguments. We have gone through the same, heard the ld. counsel for the parties and have also gone through the record of the case, carefully.
21. The ld. counsel for the complainant has argued that deceased Ashok Kumar purchased car after obtaining loan from State Bank of Patiala, Arya Samaj, Patiala and the loan was insured with the OPs No.1&2.The ld. counsel further argued that Ashok Kumar died on 10.10.2014 and the complainant lodged the claim with the OPs. But the claim was repudiated on the ground that the insured was suffering from chronic kidney disease, diabetes mellitus, hypertension and had underwent renal transplant prior to the commencement of the risk. The ld. counsel further argued that OPs produced the false and forged proposal form by forging the signatures of Ashok Kumar. The ld. counsel further argued that blank proposal form was signed by Ashok Kumar which was lateron filled by the officials of the OPs. The ld. counsel further argued that the complainant also filed complaint before Insurance Ombudsman. The ld. counsel further argued that the claim was wrongly repudiated and prayed that the same be allowed. The ld. counsel relied upon the citations Manish Goyal Vs. Max Bupa Health Insurance Co. Ltd. & Others 2018(2)CLT 205 and Bharti Axa Life Ins.co. Ltd. and others Vs. Mamta Kumari 2018(3)CLT 208.
22. On the other hand the ld. counsel for OPs No.1&2 has argued that Sh.Ashok Kumar while obtaining the loan has concealed about his serious illness and he has underwent renal transplant before commencement of the risk. The ld. counsel further argued that the complainants have made allegations of forgery which require thorough investigation and as the proceedings before the Forum are summary in nature therefore, the civil court is competent to adjudicate the matter. The ld. counsel has relied upon the citation  of the Hon’ble Supreme Court of India passed in Life Insurance Corporation of India Vs. Surinder Kaur and others Civil Appeal No.5334 of 2006 decided on 1.12.2006. The ld. counsel has further relied upon the judgment M/s Bajaja Allianz Life Insurance Vs. Bhupinder Singh passed on 9.1.2020 by the Hon’ble State Consumer Disputes Redressal Commission, U.T., Chandigarh , wherein the dispute is with regard to the forged signature and the report of  forensic expert is required and thus dispute can be adjudicated by the competent civil court. The ld. counsel has also relied upon the judgment passed by the Hon’ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh in the case titled as Kirpal Singh Vs. The Shiwalik Planners Pvt. Ltd., Consumer Complaint No.952 of 2017 on the point that wherever fraud is involved, then the parties are to get the matter decided from the competent Civil Court.
23. To prove the case Smt.Ranjita Chawla has tendered her affidavit,Ex.CA and has deposed as per the complaint, Ex.C1 is statement of account  of State Bank of Patiala,Ex.C2 is order of Insurance Ombudsman,Ex.C3 is death certificate of Ashok Kumar,Ex.C4 is the letter written to the  Manager SBI Life Insurance by Ranjita Chawla,Ex.C5 is the legal notice,Ex.C6 is reply of legal notice,Ex.C7 is proposal form,Ex.C8 is a letter of SBI Life ,ExC9 proceedings before Insurance Ombudsman.
24. On the other hand, the OPs No.1&2 tendered affidavit of Ms Neelam Singh, who has deposed as per the written statement ,Ex.OP1 is proposal form, Ex.OP2 is also insurance policy, Ex.OP3 is certificate of insurance, Ex.OP4 is investigation report,Exs.OP5 to OP10 are the discharge summary of Surya Kidney Care center,Ex.OP1 is the certificate  issued by Surya Kidney Care Center in which it  is mentioned that Mr.Ashok Kumar underwent Renal Transplant on 16.11.2011 and discharged on 22.11.2011,Ex.OP12 is the Employer’s certificate for death claim of Ashok Kumar, Ex.OP13 is the rejection letter by SBI LIC,Ex.OP14 is also repudiation letter,Ex.OP15 is proceedings of Insurance Ombudsman,Ex.OP16 is legal notice sent by the complainant and Ex.OP17 is the reply to the legal notice.
25. In the pleadings, the complainant has stated that in the proceedings before Insurance Ombudsman the OPs produced false and forged proposal form by forging the signatures of Ashok Kumar husband of the complainant which was lateron filled by the OPs. So it is clear that fraud has been pleaded by the complainants before this Forum. The complainants have also filed an application for comparing of signatures but that application was declined by our predecessor holding that where fraud is pleaded then there is no jurisdiction of the Forum. It is clear from various citations by the OPs including the citation Hon’ble Supreme Court of India in  Life Insurance Corporation of India Vs. Surinder Kaur and others (Supra) that where there is complicated disputed facts, then the Consumer Forum has no jurisdiction to try the matter. The ld. counsel has also cited the judgments M/s Bajaja Allianz Life Insurance Vs. Bhupinder Singh and Kirpal Singh Vs. The Shiwalik Planners Pvt. Ltd., in which it has been clearly held that where fraud has been pleaded by the complainant then the Consumer Forum lays its hands off from the matter and leaves the parties to get the matter decided from a competent Civil Court.
26. So there is clear cut decision of the Hon’ble Supreme Court of India and Hon’ble State Consumer Disputes Redressal Commission Punjab Chandigarh that where fraud is pleaded then the parties be relegate to knock the door of competent Civil Court and this Forum has got no jurisdiction to adjudicate the matter as the proceedings before the Consumer Forum are summary in nature and have to be proved by way of affidavit and where fraud is pleaded voluminous evidence is required to determine the matter and the parties have to knock the door of competent civil court.
27. Even the OPs have also lead voluminous evidence  that deceased Ashok Kumar before he got policy was suffering from kidney disease and underwent renal transplant in the year 2011. All the record is on the file. The case was also investigated and the report is Ex.OP4, in which it is mentioned in detail that Ashok Kumar underwent renal transplant on 16.11.2011 in the kidney hospital. All the discharge summaries of Surya Kidney Care centre are on the file. All these facts were concealed by Ashok Kumar before taking the policy.
28. The repudiation letter  of claim is Ex.OP14, in which it is mentioned that Ashok Kumar was suffering from chronic kidney disease, diabetes mellitus, hyper tension and  had underwent Renal Transplant prior to the commencement  of the policy. So the claim was rejected.
29. So keeping in view the law laid down by the Hon’ble Supreme Court of India, Hon’ble State Commission Punjab Chandigarh and Hon’ble State Commission U.T.Chandigarh, that where fraud is pleaded the Consumer Forum has no jurisdiction to adjudicate the matter and the parties be left to knock the door of competent Civil Court.
30. In view of our above discussion we are of the opinion that as in the present case fraud has been pleaded by the complainants, therefore, this Commission has no jurisdiction to go into the facts of the complaint and the same is accordingly dismissed. Parties are to bear their own costs.              

ANNOUNCED

DATED:22.12.2020     

                                  Y.S.Matta                          Jasjit Singh Bhinder

                                    Member                                       President